Hospital characteristics associated with timeliness of care in veterans with lung cancer.
BACKGROUND
Timeliness is one of six important dimensions of health care quality recognized by the Institute of Medicine.


OBJECTIVE
To evaluate timeliness of lung cancer care and identify institutional characteristics associated with timely care within the Veterans Affairs (VA) health care system.


METHODS
We used data from a VA nation-wide retrospective chart review and an independent audit of VA cancer programs to examine the association between time to first treatment and potentially explanatory institutional characteristics (e.g., volume of lung cancer patients) for 2,372 veterans diagnosed with lung cancer between 1 January 2002 and 1 September 2005 at 127 VA medical centers. We developed linear mixed effects models to control for clustering of patients within hospitals and we stratified analyses by stage.


RESULTS
Median time to treatment varied widely between (23 to 182 d) and within facilities. Median time to treatment was 90 days in patients with stage I or II cancer and 52 days in those with more advanced disease (P < 0.0001). Factors associated with shorter times to treatment included a nonacademic setting and the existence of a specialized diagnostic clinic (in patients with limited-stage disease), performing a patient flow analysis (in patients with advanced disease), and leadership beliefs about providing timely care (in both groups). However, institutional characteristics explained less than 1% of the observed variation in treatment times.


CONCLUSIONS
Time to lung cancer treatment in U.S. veterans is highly variable. The numerous institutional characteristics we examined explained relatively little of this variability, suggesting that patient, clinician, and/or unmeasured institutional characteristics may be more important determinants of timely care.
Schultz
Ellen M
EM
Center for Primary Care and Outcomes Research, Stanford School of Medicine, Stanford, California, USA.
Powell
Adam A
AA
McMillan
Alex
A
Olsson
Julie K
JK
Enderle
Mark A
MA
Graham
Barry A
BA
Ordin
Diana L
DL
Gould
Michael K
MK
D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D013997:Time Factors; D014728:Veterans